Tobacco products are the only legally available products that can kill up to one half of their regular users if consumed as recommended by the manufacturer, according to the International Union Against Tuberculosis and Lung Disease.

“With its formidable economic and political resources, the tobacco industry is fighting to prevent passage of new tobacco control laws and policies around the world,” according to the International Union. “Article 5.3 of the Framework Convention on Tobacco Control calls for parties to the treaty to resist these efforts to undermine public health and continue the spiraling pandemic of tobacco-related disease.”

There is a fundamental conflict of interest between the goals of the tobacco industry and the goals of governments in promoting public health. The industry’s interference has, time and again, weakened and delayed the enforcement of public health policies around the world. It is because of this interference that in India strong pictorial warnings on tobacco packs have been diluted and/or their implementation postponed several times in the past.

In November 2008, The Indian Ministry of Health and Family Welfare revealed before the Central Information Commission that tobacco industry is putting “pressure” to relax the tobacco control policies, according to The Hindu, 14 November 2008.

In fact the tobacco industry, Indian Hotel Association and other allied agencies had filed more than 70 court cases against tobacco control policies in Indian courts in September 2008, and due to aggressive lobbying by such agencies, the Group of Ministers formed earlier to review the pictorial warnings on tobacco products, diluted the pictorial warnings provision and postponed the implementation of pictorial warnings on tobacco products at least six-times.

Jagdeep Singh Rana of the Union says that ‘Tobacco industry people have been approaching various sections of officials and activists in Chandigarh (the first Indian city to go smoke-free in 2007) to find support for dilution/ defeating the initiative to license tobacco vendors. Many attempts were made by the industry in this regard in the past.’

Apart from interfering directly in policy making and devising ways to circumvent the existing tobacco control laws, the tobacco giants under the garb of corporate social responsibility are active in sponsoring/financing not only social activities like film/music concerts/sports events, but also funding educational activities.

One such example is the Godfrey Phillip Bravery Awards (given for acts of physical and social bravery and humanitarian service) instituted in India in 1990. Godfrey Phillips India states as its core philosophy “Making a better world for a better tomorrow.” Through all such promotional campaigns, the tobacco industry blatantly washes off its sins in public with the air of a do-gooder and gets away with it too. It makes a mockery of tobacco control efforts and puts the peddlers of death on a pedestal.

In China, which boasts 350 million smokers and nearly 1.2 million smoking related deaths every year, it is a different story altogether with the government being in conflict with itself over health policies as it is the sole owner of the tobacco industry. The industry is very strong in terms of the huge quantity of the cigarettes produced. So it is not surprising that government efforts to bring down the incidence of smoking are weak and half-hearted.

Indonesia, the third largest consumer of tobacco, has not signed the Framework Convention on Tobacco Control. Popular music/sports/cultural events which mainly attract teenagers are sponsored by tobacco companies with a view to market their products to young, potential new customers. There is no ban on advertising tobacco on street billboards or night time television. The result of aggressive marketing and promotional strategies targeting women, children and youth is obvious. Indonesia has the world’s highest percentage of young smokers with an estimated one million smokers being less than 16 years of age.

Irina Berezhnova, Director of The Union Russia Office, says that, “In Russia the tobacco corporate fund social activities to improve environment, education, poverty reduction, and finance art events and institutions. Likewise, Mirta Molinari of the Union says: “in Latin American countries they help governments under the garb of Corporate Social Responsibility with the sole aim of circumventing existing legislation, delaying implementation of tax increase and smoke free policy and promoting their products to increase the consumption mainly amongst youths and women.”

According to Tara Singh Bam, Technical Advisor at the Union, who is involved with tobacco control activities in Indonesia and Nepal, “In Nepal the tobacco industry lobbies with the officials of the Ministries of Finance, Health and Population, and of Law and Justice and also funds sports activities. Tobacco tax is still low in Nepal because the tobacco industry is a member of the tax committee under Ministry of Finance. It has also entered into litigation with the Ministry of Health and the government to delay implementation of pictorial health warnings occupying 75% area of tobacco packs and the matter is pending in the Supreme Court of Nepal.”

In Australia the industry’s opposition to plain tobacco packaging has been deviously aggressive and includes legal and economic threats, funding front groups of retailers and think tanks to oppose health policies, making political donations, funding legal actions against the government using trade treaties, and funding mass media campaigns calling Australia a nanny state.

Ehsaan Latif, Director of Tobacco Control at the Union would like governments to be very transparent in their dealings with the tobacco industry, as Article 5.3 under FCTC says that tobacco industry should not be involved in framing health policies. He says that, “It is the duty of the states to protect public health policy from public health interference of the industry. The state should share with the civil society every direction that they have with the tobacco industry and harness the expertise and technical knowledge available with the civil society in countering this epidemic. But what we want is a complete ban on tobacco advertising and sponsorship.”

It is vital to understand that unless all such covert and blatant tobacco industry interference in public health policies is checked, the implementation of other health interventions (smoke-free policies, pictorial warnings on tobacco products, ban on tobacco advertising, promotion and sponsorship) will continue to be weakened, slowed and challenged. It is important to counteract the false propaganda of the tobacco giants with the existing evidence based information, and to inform the public and the media about their tactics which undermine public health policies.

“Industry interference is the number one obstacle to the implementation and enforcement of the global tobacco treaty,” said Kathy Mulvey, international policy director of Corporate Accountability International. “Article 5.3 is the lynchpin of the treaty, determining whether or not countries will be able to reverse this preventable epidemic without the tobacco industry standing in their way.”

Anne Jones, CEO of ASH Australia said: “Governments must put health first and ahead of the vested interests of an industry that targets children and promotes lethal products that kill and rob people of their good health and years of life. Governments must stand together and fight the rapacious industry by protecting health policies from tobacco industry interference.”

This article estimates the economic size and the impact on government revenues of cigarette smuggling worldwide and formulates economic policies that can be used to effectively address the problem. First, information from various sources are combined and a global map of smuggling routes for cigarettes is described. By examining the international cigarette trade records, the hub/transit countries in six regions of the world are identified. Second, a variable that measures smuggling incentives for cigarettes is defined and computed for 110 countries. Third, a static global demand model for cigarettes (that includes the smuggling incentives variable) is specified and robustly estimated. Using the estimation results, global price and income elasticities of cigarette demand are obtained as −0.41 and 0.37, respectively. It is estimated that in 1999, 3.4% of global cigarette consumption was smuggled and 7.4% of tax revenue was lost to smuggling. Fourth, the best policy options are identified to achieve the objectives of both public health agencies (less consumption, less smuggling) and governments (less smuggling, more revenue). A tax-induced increase in real retail cigarette prices and an improvement in anti-smuggling law enforcement (as proxied by the corruption indicator) are found to significantly increase government revenues while decreasing global consumption and smuggling. Furthermore, when the tax increase is not accompanied by an improvement in law enforcement, then global smuggling of cigarettes would increase, but governments would still enjoy increased tax revenues.

THE Institute of Public Affairs has failed to disclose that it is receiving tobacco money, despite waging a strong campaign against the federal government’s plain-packaging legislation.
While describing itself as an ”independent” public policy think tank, the IPA will not reveal who funds its research and widely circulated publications. The Herald has learnt at least one Australian tobacco company is contributing to the IPA’s coffers.
A spokesman for British American Tobacco Australia, Scott McIntyre, said the company was a member of the IPA. Corporations or individuals must donate money as a condition of membership.
The IPA’s 2010 annual report shows $1.7 million of income, of which about $500,000 came from donations and $900,000 from ”subscriptions”. The institute will not say how much of that money comes from tobacco companies.
In response to the Herald’s questions, the IPA’s Tim Wilson declined to confirm tobacco funding and said the group’s policy not to disclose donors was the result of a letter sent to ”members and potential supporters of the IPA” in 2006 by the federal Labor frontbencher Kelvin Thomson.
”It is because of actions like those of Kelvin Thomson, MP, the IPA does not disclose its membership list,” Mr Wilson said.
In the early 2000s, the institute admitted publicly that it received money from cigarette companies, but as it runs its most crucial campaign in support of the tobacco industry, the group remains tight-lipped about its donors.
While Mr Wilson has told the media that ”any funding [the IPA receives] has no impact on the policy positions we take whatsoever”, this clashes with a statement by Alan Moran, an IPA director. During the Productivity Commission’s 2001 inquiry into the national access regime, Dr Moran said of IPA: ”We’ve got about 4000 funders … there are occasions when we may take positions which are somewhat different from those of the funders. Obviously that doesn’t happen too often, otherwise they’d stop funding us, but it does happen occasionally.”
Philip Morris refused to confirm or deny its support of the IPA, and Imperial Tobacco Australia denied funding the IPA or ”other think tanks”.

AT LEAST one tobacco company has moved to frustrate the impact of the Gillard government’s plain packaging laws by distributing metal cigarette packets for sale.

The Peter Stuyvesant-branded metal packets are now available for sale before the new regulations – due to take effect in December – which will outlaw the sale of packets bearing any brand or logo.The Health Minister, Tanya Plibersek, warned retailers not to get burned by stocking metal cigarette tins that would not comply with the plain packaging regulations, due to take effect in December, and would become illegal to sell.

However, while the law may prevent sale, it will not prohibit people continually using the metal packet to hold their cigarettes.

The government is also about to introduce draconian penalties against tobacco smugglers, following industry claims that plain packaging would see an influx of black market tobacco. The attorney-general will today announce jail terms of up to 10 years for smuggling tobacco as part of tougher customs laws which will create a specific new offence aimed at black market tobacco traders.

Penalties range from two to five times the amount of duty evaded. Tobacco bought overseas is liable for a $420 excise duty.

This paper presents the findings of research over two decades and across five countries on the topic of plain packaging. It includes the results of 24 published experimental studies which have examined the likely impact of plain packaging on young people and current smokers (Section 5) i. It also summarises the results of research papers that analyse industry arguments about barriers to legislation resulting from international law and trade agreements (Section 7).

The main findings from this compilation of literature are as follows:

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In a worldwide environment of increasing prohibition of tobacco advertising and sponsorship, the cigarette pack has become the key marketing tool employed by the tobacco industry to attract and retain customers. (Section 3)

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The tobacco industry uses cigarette pack technologies and innovations in design to communicate particular attributes about each brand and by extension the personality and social status of its users. (Section 4)

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Current pack colours and imagery can dilute the impact of graphic health warnings. (Section 5.2.1)

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Unregulated package colouring and imagery contribute to consumers’ misperceptions that certain brands are safer than others. Removing colours from cigarette packs and misleading terms such as ‘smooth’, ‘gold’ and ‘silver’ would reduce false beliefs about the harmfulness of cigarettes. (Section 5.2.2)

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Adults and adolescents perceive cigarettes in plain packs to be less appealing, less palatable, less satisfying and of lower quality compared to cigarettes in current packaging. Plain packaging would also affect young people’s perceptions about the characteristics and status of the people who smoke particular brands. (Section 5.2.3)

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Plain packaging featuring larger graphic health warnings (75% front of pack) will both reduce the appeal of the pack and strengthen the impact of the warnings. (Section 5.2.4)

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British American Tobacco has claimed that the legislation will not be effective, pointing to the results of an international analysis it has commissioned (and provided data for) on the impact of health warnings on sales. Health warnings have a different objective to plain packaging and monthly variations in sales data are not an appropriate indicator of effectiveness. In any case the data on which this analysis is based is highly selective and the specifications of the modelling incorrect in at least one important respect. (Section 7.1).

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The Alliance of Australian Retailers alleges that plain packaging would damage retailer business, increasing transaction time at the counter due to difficulties in differentiating between brands. The AAR suggests that as a result, customers would switch to discount outlets. However, any loss of convenience at retail outlets will apply equally to discount and convenience outlets. Measures including labelling of the containers where packs are stored and brand names printed on packs in a clear font style and size would assist retailers to quickly indentify and retrieve particular brands. (Section 6.3 and 7.2)

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The tobacco industry claims plain packaging represents an acquisition of intellectual property and as such is prohibited under the terms of various international trade agreements. The industry has suggested the Australian Government would be forced to compensate the industry

i V3 19.05.11.We intend to add to this review results of several more studies that we are informed are close to publication. 3

in billions of dollars. Papers by experts in constitutional and trademark law on the other hand suggest that international agreements permit governments to restrict use of trademarks to protect public health. They advise that plain packaging will not be an acquisition of intellectual property, as the Government does not intend to use the logos or brand imagery; it will simply be restricting the use of these marketing tools on cigarette packages. If Courts were to rule that restriction of use of trademarks was an acquisition of property, then the legislation has been drafted to allow the use of trademarks with limitations. (Section 7.3)

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Plain packaging has been carefully considered and researched in Australia and overseas for some 20 years, but contrary to claims by tobacco companies it has not been abandoned as a policy option. The paper provides links to statements by parliamentarians in New Zealand, France, the United Kingdom and the European Union, which are all either undertaking public consultation on plain packaging or have named plain packaging among proposals for future tobacco control strategies. (Section 7.4)

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Companies have claimed that the legislation will reduce price and competition in the market. Opinions of industry analysts about the likely effects on competition are mixed. As pointed out by Deloitte MCS, future governments have open to them the option of further increasing excise and customs duty on tobacco products should average prices of tobacco products fall. (Section 7.5)

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Tobacco industry claims that plain packaging will increase illicit trade are exaggerated and misleading. The industry’s estimation of the current size of the illicit market in Australia (15.9%) is based on one very small survey (949 people) with a very low response rate. The Government’s National Drug Strategy Household Survey of more than 23,000 people suggests that only about 0.2% of Australians (1.2% of smokers) use unbranded tobacco products ‘half the time or more’. The Australian Government’s draft plain packaging legislation specifies that anti‐counterfeiting markings will be permitted on plain packaging, and the Australian Taxation Office and the Australian Customs and Border Protection Service should and no doubt will continue to vigorously pursue technologies and other surveillance and enforcement strategies to prevent the evasion of excise and customs duty in this country. (Section 7.6)

In summary there are strong grounds for believing that current packaging glamourises smoking and that tobacco products packaged in a standardised colour, typeface and form would:

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improve the effectiveness of health warnings

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reduce misconceptions about relative harmfulness of various brands and

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reduce the overall appeal of smoking

The intensity of opposition to plain packaging legislation by tobacco companies suggests that tobacco industry executives believe that such measures will reduce sales and company profits.

Tobacco corporations have been challenged by governments in recent years. But despite the latter’s smoking and marketing bans, the number of smokers continues to grow. That means increased burden on public health systems and, ultimately, more deaths caused by the world’s most preventable killer.

Death-by-smoking statistics are sobering. Six million people die each year from tobacco-related diseases, a figure expected to hit eight millions by 2030. One in two long-term smokers will die – half in middle age.

The tobacco industry has long sought to protect profits and keep people puffing. But as the World Health Organisation (WHO) marks “World No Tobacco Day” on Thursday, the UN’s health body has accused the industry of “nefarious” attempts to stymie control measures.

Tobacco corporations have reason for concern amid worldwide efforts to wean people off their products, and keep the young from ever starting.

The landmark WHO Framework Convention on Tobacco Control in 2005 has been ratified by 174 countries. The ambitious agreement obliges governments to raise taxes, enforce smoking and advertising bans, and offer programmes to help people quit.

‘Ruthless and devious enemy’

The WHO’s Director-General Margaret Chan has criticised the tobacco industry for interfering with the treaty, highlighting lawsuits launched in Uruguay, Norway, Turkey and Australia – all countries that moved towards its implementation.

“We are often criticised because we enter so-called emerging markets, as if that makes them smoke. They’ve been smoking for centuries.”

– Louis Camilleri, Chief Executive of Philip Morris

“We have an enemy, a ruthless and devious enemy,” said Chan. “It is horrific to think that an industry known for its dirty tricks and dirty laundry could be allowed to trump what is clearly in the public’s best interest.”

The tobacco industry, however, says it is involved in global control initiatives. At a May 9 shareholders meeting in New York, Chief Executive of Philip Morris, Louis Camilleri, challenged criticism saying anti-smoking proponents were “at times blinded by their hatred” of the tobacco industry.

“We recognise that cigarettes are a cause of very significant diseases and that’s why we try to operate our business in the most responsible manner possible,” Camilleri said.

While smoking in the developed world has been steadily dropping, it is burgeoning in the developing one. The tobacco corporations have been accused of targeting poorer regions such as Africa. It is predicted that more than 80 per cent of tobacco-related deaths will occur in low and middle-income countries by 2030.

“We are often criticised because we enter so-called emerging markets, as if that makes them smoke. They’ve been smoking for centuries,” said Camilleri.

Australia is the world’s first country to pass a “plain-packaging” law, after leading the way in fighting tobacco marketing over the past decade. The effort has paid off. Smoking rates in Australia declined to 15.1 per cent in 2010 from 30.5 per cent in 1998.

The new legislation, to take effect in October 2012, would strip all cigarette packages of bright colour, fancy designs, as well as sleek branding and logos. British American Tobacco, Imperial Tobacco and Philip Morris have launched High Court challenges against the Australian law, saying it infringes on trademark rights.

Anti-smoking campaigners say studies show children and teenagers are attracted to the bright colours and sleek designs emblazoned on packs that lure them to smoking. Tobacco proponents, however, dispute such research saying there is no hard evidence that packaging plays any such role.

It appears that tobacco companies are also assisting in targeting the Australian law at the World Trade Organisation (WTO). Honduras and Ukraine have lodged “consultation requests” before the WTO – a move that could signal the beginning of a legal battle.

A British American Tobacco spokeswoman, who requested anonymity, told Al Jazeera: “We have openly engaged with governments, including Ukraine and Honduras, to express our views and concerns on this issue … In the case of the Ukraine, lawyers retained and paid for by British American Tobacco are providing advice and counsel … We have offered to provide them (Honduras) with all the support they require.”
When queried about the WHO’s interference allegations, Imperial Tobacco spokesman Simon Evans said his company takes an active role in tobacco-control efforts, but added that measures need to be evidence-based.

Young children are attracted to the bright colours of cigarette packs [WHO]

“We will also continue to challenge disproportionate and unnecessary regulation that is solely designed tostigmatise smokers and denormalisesmoking. Evidence for the introduction of invasive legislation is often non-existent or flawed,” said Evans.

Meanwhile, in the United Kingdom, government consultation on plain-packaging is under way. It, too, has been met with tobacco industry pressure – this time in the form of support for a lobby group fighting the proposal.

The Freedom Organisation for the Right to Enjoy Smoking Tobacco, or Forest, has aggressively attacked the plain-packing proposal, launching a “Hands Off Our Packs” campaign.

“Plain packaging is the persecution of minority lifestyle choice,” said Forest’s Simon Clark.

According to a Financial Times report, tobacco corporations will provide 330,000 pounds (US$518,000) to the group this year.

Battle over US bill

Anti-tobacco proponents have long argued that raising cigarette prices is the most effective way to curb smoking, especially among the young and the poor. Tobacco corporations, unsurprisingly, disagree.

In the US state of California, voters will go to the ballot box on June 5 to determine the fate of Proposition 29, a bill that would hike the state tax on cigarettes by $1 a pack. The move would raise about $735m annually, most of which would go towards cancer research.

It is predicted that Proposition 29 would also mean a $1bn hit annually to California tobacco sales, by forcing people to quit smoking or deterring them from starting.

Opponents of the bill say there is no evidence that increased taxes would lead to a decline in smoking. Proposition 29 would set up an unaccountable bureaucracy to disburse the funds, and there is nothing stopping the money from going to out-of-state cancer researchers, they say.

The vote is a prime example of how Big Tobacco spends big dollars to defeat control measures. Led by Philip Morris and R.J. Reynolds, the opposition has spent about $40m on radio and television ads so far to kill the measure. A similar 2006 bill in California proposing a $2.60 tax on a pack of cigarettes failed after Big Tobacco paid $67m on advertising.

Proponents of the new tax have spent roughly $8.6m, including $1.5m from Lance Armstrong, a cancer survivor and a former Tour de France champion. New York Mayor Michael Bloomberg chipped in $500,000.

The ad battle appears to be working in the tobacco industry’s favour. Survey results show about half of likely voters supporting Proposition 29 – down from more than two-thirds support in March.

Today is World No Tobacco Day. The World Health Organisation says on its website: “Tobacco use is one of the leading preventable causes of death. The global tobacco epidemic kills nearly six million people each year, of which more than 600,000 are people exposed to second-hand smoke. Unless we act it will kill up to eight million people by 2030.”

Closer to home, Jim Middleton, chairman of Clear the Air, says: “More than 7,000 people die each year in Hong Kong from tobacco-related illnesses, of which 1,400 die from the effects of passive smoking.” He adds that there are a number of measures which the government should adopt.

These include making licensees responsible for the prevention of smoking on their premises at the risk of losing their licences, and banning smoking in all areas of licensed premises, including patio areas, and within 15 metres of the venue. Tobacco should be sold in plain packages, from under the counter.

And he challenges Hong Kong’s new government to make Hong Kong tobacco-free by 02-02-2022.

Striking boxes and smart lettering must give way to drab colours and graphic warnings, local groups say

Jennifer Cheng and Christy ChoiMay 31, 2012

Fancy colours and lettering on cigarette packs should become a thing of the past to discourage smoking, local concern groups said yesterday to promote today’s World No Tobacco Day.

The Hong Kong Council on Smoking and Health, along with University of Hong Kong academics and public experts, joined forces yesterday to call for plain packaging “in order to prohibit tobacco companies from promoting sales through fancy designs on cigarette packs”. World No Tobacco Day is promoted by the World Health Organisation.

Tobacco advertising is illegal in Hong Kong. At least half of every cigarette pack’s front and back side must be used for a pictorial health warning, but the tobacco firms can design the rest of the box.

Plain packaging would prevent tobacco brands from displaying trademarks, graphics and logos, and require at least 75 per cent of the box to be used for a shocking pictorial health warning. The hotline for a service to help kick the habit would be prominently displayed, font styles and sizes for all brands would be identical, and the background would be the same, drab colour: Australia chose a dull, unappealing green.

So far, Australia is the only country to have adopted plain packaging, which it will enforce starting in December. The tobacco industry has launched several legal actions against the measure.

Hong Kong could expect the same legal challenges if it adopted a similar law, said Lisa Lau Man-man, chairman of the non-profit Council on Smoking and Health. Industry retaliation would not be low-key, she said, but this only proved that it recognised the threat of plain packaging to its business.

Although Hong Kong has one of the lowest numbers of smokers globally, there were still 657,000 in the city as of 2010 – the last year for which figures are available. Half of smokers will die of tobacco-related illnesses, the WHO warns.

The Hong Kong Council on Smoking and Health said it would do some research on how best to guide the government in implementing plain packaging.

Fiona Sharkie, executive director of Quit Victoria – who played an active role in pushing plain packaging in Australia – said: “The pack is a mini billboard that says something about the smoker and who they are. Plain packaging would remove the allure of a pink, round-edged box designed to appeal to women, or brightly coloured boxes for children.”

Many smokers supported the measure, she said. “I’ve never met a smoker who has wanted their children to start smoking, and if plain packaging can stop children from starting smoking, then it’s worth it.”

Lee Mer, convenor of Hong Kong’s I Smoke Alliance, said: “They want to dress the cigarettes like they’re going to a funeral.”

Lau said the council had written to chief executive-elect Leung Chun-ying, urging him to push for plain packaging. But a spokeswoman for Leung said no letter had been received, and would not comment on the issue.

The draft, released for public consultation last week, echoes a controversial plan first outlined by Health Minister Chen Zhu in April that would see consultations with doctors on quitting smoking covered by basic medical insurance and the drugs involved in such treatment included in the essential drugs catalogue.

While many doctors and tobacco control advocates support the plan, saying that giving smokers professional help to quit will improve public health and cut the social cost of tobacco use, others question whether it is appropriate to extend limited basic medical insurance to cover such drugs.

The mainland is the world’s largest producer and consumer of tobacco, accounting for 40 per cent of cigarette sales. A Ministry of Health report in 2010 said there were more than 356 million smokers on the mainland and over a million smoking-related deaths every year.

Wang Hongzhi , a pharmaceutical industry specialist at management consultancy Allpku, said using drugs to treat smoking addiction was ineffective, as clinical trials showed the most effective drug was only 10 percentage points more effective than a placebo. Authorities in other countries had also linked such drugs to suicidal tendencies and cardiovascular diseases, he said.

And even though such drugs are covered by basic medical insurance in some countries, such as Australia, that did not necessarily mean Beijing should follow suit as the level of social security on the mainland was much lower, he said. The full course of treatment costs more than 4,000 yuan (HK$4,899), while the premium for basic medical insurance in rural areas is about 300 yuan a year, Wang said, adding that the reimbursement level for essential drugs in rural areas was only 50 per cent.

He said that including drugs used in treating smoking addiction in the essential drugs catalogue should not be a priority, given that the mainland only extended insurance coverage to serious diseases such as kidney failure and lung cancer in March.

“The point is you can’t quit smoking solely because of the drugs or willpower,” Wang said. “There are many other things that need to be addressed first, otherwise it is just not an efficient use of money.”

But Dr Xiao Dan , director of the smoking cessation clinic at Beijing’s Chaoyang Hospital, said that extending insurance coverage should be a top priority as it was cheaper to treat tobacco addiction than to treat the cardiovascular diseases that would otherwise develop.

Xiao said that some of her patients, after hearing that the first phase of drug treatment would cost them more than 2,100 yuan, would only accept one or two packets of drugs, or none at all, saying they would rely on willpower instead.

“Smoking addiction is a chronic ailment and drug treatment is a way of treating it,” she said. “The priority of basic medical insurance should be to focus on the burden on people’s health, and smoking is responsible for an enormous [burden].”

Xiao also said that helping smokers quit would be good news for the 740 million non-smokers on the mainland who had to put up with second-hand smoke.

Some tobacco control experts who support the idea, such as Professor Zhi Xiuyi , director of the Lung Cancer Treatment Centre at Capital Medical University, propose a gradual approach. He said pilot programmes should first be conducted in designated cities that already have hospital-based smoking-cessation clinics, had introduced bans on smoking in public places and had higher levels of social security.

That would let doctors identify patients suffering from serious addiction and those who should be treated with drugs. “Not all patients need to be treated with drugs, and we need to have trained, experienced doctors for that purpose,” Zhi said.

Jiang Yuan , deputy director of the tobacco control office at the Chinese Centre for Disease Control and Prevention, said extending basic medical insurance to cover smoking cessation was only a small part of tobacco control and should only be implemented after other measures, such as bans on smoking in public areas, were in place, otherwise patients would just start smoking again.

“Studies show tobacco prices, a ban on smoking in working areas and health warnings … are the three most effective measures to encourage people to quit,” she said. “We need to improve the general environment for tobacco control first.”